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Fentanyl use by opioid addicts on the rise

Drug addicts are turning to highly potent fentanyl now that OxyContin is no longer available.

Sherri Dolk, who lost her eldest daughter, Tina Espey, 19, to a fentanyl overdose last December, has since become active in raising awareness about fentanyl addiction. (EDUARDO LIMA / FOR THE TORONTO STAR)

Health-care workers are reporting anecdotally that use of the most powerful opioid is on the rise, mainly as a result of the removal of OxyContin from the Canadian market in early 2012, as addicts shift their behaviour to other narcotics.

More worrying are reports that illicitly made fentanyl, potentially more potent than the already highly potent pharmaceutical-grade medication, is being sold on the streets, including in Ontario.

In 2011, there were 102 overdose deaths involving fentanyl, 13 in Toronto, according to the most recent statistics available from the Ontario coroner’s office.

Known by the brand name Duragesic when sold in patch form, fentanyl is approximately 100 times stronger than morphine. Once used mainly to treat patients in palliative care or suffering cancer-related pain, who have built up a tolerance to other opioids, it is now finding its way into tinfoil rolls smoked by 18-year-olds.

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“It was but a blip on the radar 10 years ago, when it was almost exclusively used in patients with cancer, but now I would say it’s becoming much more of a concern,” said Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre and a member of the medical advisory board of Advocates for the Reform of Prescription Opioids, a binational organization.

“I know for a fact that there are people who live in Toronto and abuse fentanyl.”

When taken for medical purposes, a fentanyl patch is applied to the skin and slowly releases the medication into the body over a 72-hour period. But to get a quick high, users will try a host of methods, including scratching the medication off the patch and smoking it, cutting it up into pieces and applying it to their gums, or in some rarer cases, ingesting the whole patch.

The patches have also become one of the prime motivations behind a string of recent pharmacy robberies, according to the Ontario Pharmacists’ Association.

The lack of hard data makes it difficult for medical experts to say definitively if one opioid is more popular than another at any given moment, as there is no comprehensive, real-time surveillance system for overdoses in Ontario. Numbers from the coroner for any given year can take months to compile.

The Toronto Drug Strategy and Toronto Public Health say they have little evidence about the prevalence of specific opioids, but that anecdotally the use of all opioids is up, including fentanyl.

Toronto associate medical officer of health Dr. Rita Shahin said she has also heard reports of people testing positive for it, believing they had consumed oxycodone.

In June, the Canadian Centre on Substance Abuse issued a drug alert warning illicit fentanyl was appearing in pill and powder form and being sold as OxyContin, heroin or other substances in some jurisdictions.

And in Peterborough earlier this year, officers seized “designer tablets,” passed off as oxycodone pills, which proved to be fentanyl.

“We were pretty happy we got lucky and found them before they hit the streets,” said Det.-Sgt. Laine Schubert, of the Peterborough police drug unit, adding that officers have seen a growing demand for the pharmaceutical-made patches, which have a high street value.

Peterborough is hoping to get ahead of the curve on the problem. A coalition of organizations, including the health unit, are in early discussions to initiate a formal patch exchange program, where people who have legally received a prescription for fentanyl promise to return their old patches to a pharmacy for proper disposal before receiving new ones.

Once removed from the skin, a patch still contains some of the active ingredient, making it tempting to addicts, some of whom resort to “dumpster diving” — rummaging through garbage where they know patches can be found.

In 2010, one-quarter of all drug overdoses in Peterborough (five out of 21) were due to prescription opioids.

There’s agreement what is needed to combat fentanyl’s rising popularity is more awareness about the dangers of the drug and better access to support groups, addiction services and the overdose lifesaver Naloxone.

Sherri Dolk, of Barrie, knows the devastating effect fentanyl can have on an addict. She lost her eldest daughter, Tina Espey, 19, to a fentanyl overdose on Dec. 2 last year, one day after the family’s Christmas dinner.

Espey had become addicted to OxyContin in high school, but after it was pulled, somebody introduced her to fentanyl.

“I started to do research, I was totally clueless about prescription drugs,” said Dolk. “I was pretty concerned when I found out about fentanyl. Somebody made us aware of it. It was really scary.”

Espey had become so addicted that she began selling everything she had, “even the clothes on her back,” to buy her drug of choice. There were many family discussions to try to get her to turn her life around. Dolk said Tina eventually wanted to go into detox, several times, but there was never a bed immediately available.

In the summer of 2012, she became clean again, and there was hope she was going to be OK. But in November, Espey returned to smoking fentanyl.

On the evening of Dec. 1, she sneaked her boyfriend into the house after everyone else had gone to bed. They did fentanyl. The boyfriend woke up around 5 a.m. the next morning. Tina did not.

Espey was among a string of recent fentanyl-related deaths in Ontario that received media attention; another was 21-year-old Cole Lockie of Keswick this past February, who left behind a 3-year-old daughter.

Dolk wants to see more information circulated about opioids, to parents in particular.

“I just wish I had realized the effect, right from the beginning, that the drug could have,” she said. “To lose a child like that, it’s absolutely devastating.”

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